medical school to graduate school transition
One reader asked today:
I am a current MD/PhD student in my first year of med school. I am just curious about your thoughts on making the transition to grad school after 2nd year vs. after 3rd year. I lean toward going into grad school after 3rd year and am trying to convince my program that it would be better for me to do it that way. I would just like to hear an outside opinion!
I guess it would make sense that if I wrote about the graduate school to medical school transition, then I would have also written about the medical school to graduate school transition that mudphudders face. I had sort of glossed over this because usually the medical school to graduate school is such a welcomed change of pace.
As I have probably written before, the endless memorization of medical school “learning” can lead to significant rust in terms of ”thinking” so most mudphudders welcome the transition to graduate school. One problem that can arise is referred to by this reader’s question. Namely, when to break away from medical school to start graduate school. I’ve known mudphudders who have started graduate school after the first, second, third and fourth years of medical school. My recommendation is to either do it after the second or third years of medical school. Second year of medical school tends to be pretty brutal at many institutions so having to come back to that from graduate school (i.e. if you left after the first year of medical school) can be a stone cold rude awakening. Every mudphudder I know who has come back from graduate school to second year of medical school has found it to be an unpleasant experience. The flip side is that there is complete continuity between the immense knowledge gained during second year into the clinical years. But I’d still advise against it. Doing the PhD after the fourth year should only be done if you have to do it that because of life-planning reasons, etc. That’s not ideal for obvious reasons so I won’t get into it.
So how to decide between starting graduate school after the second or third years of medical school? Most mudphudders do it after the second year. I think there’s a natural break there that lends itself to a smooth transition to graduate school: finish courses, may be do a couple of clinical rotations, take USMLE Step 1 (this is a MUST) and then hit graduate school. I did it that way and I have no complaints. Some mudphudders leave after the third year. This is a little unconventional but definitely not unheard of. The advantage of that is you get more clinical experience and hopefully figure out what field of medince you want to go into before you start the PhD. And when you go back to the wards, you won’t have to scramble to figure that all out. The mudphudders I know who started graduate school after the third year of medical school all wanted to gain more clinical experience and find their clinical passion before graduate school so that knowledge would inform what field they would study in graduate school and even what question to study for their dissertations. I think that is a very valid reason for finishing third year of medical school before starting graduate school. The disadvantage is mostly on the tail end of things. When you go back to medical school after finishing the PhD, you will be a fourth year. A lot is typically expected from a fourth year medical student so you will be under a lot more pressure to perform when you go back. As a third year, it’s a lot easier to use the “I just came back from my PhD (i.e. I don’t remember jack)” card than it is as a fourth year. Moreover, if you have sub-internships to do as a fourth year, that becomes even harder if your basic clerkship was 4 to 5 years ago. Or if you managed to get the sub-internship done before starting graduate school, you will still have to do another sub-I to prove to the residency committees that you still got what it takes. Either way, it will be more difficult than coming back as a third year. But definitely not insurmountable as evidenced by the number of mudphudders who have successfully done it this way. Also, after a few months back anyway, everyone is essentially accustomed to being on the wards.
The bottom line in deciding when to go start graduate school as a mudphudder will come down to how much clinical experience you need before graduate school. I say “need” instead of “want” because this experience should be for a strategic reason–e.g. so you can tailor your PhD to a particular field. If you can present a cogent argument in those terms for starting graduate school after any particular year (1st, 2nd or 3rd) of medical school, then your program should–in theory–have no problems with it. It’s safest (in my opinion) to start after second year but think about your own needs/plans for the future and do what’s best and most strategic in that regard.
April 6th, 2009 at 1:49 pm
I’m an MD/PhD student at a program where most students enter graduate school after 3rd year, and one of the advantages I’ve heard from other students is that you get to do 3rd year with your medical school classmates. I’m just finishing up 2nd year, but I’m glad that I’ll get to start 3rd year in July with my friends! Another advantage is that you can continue to have clinical experience/make connections within your (clinical) field while you’re doing your graduate school work.
As far as going back to 4th year, the advice I’ve heard is to pick a “throw-away” rotation to start with, and then don’t blow 4th year off (as some med students do).
April 6th, 2009 at 3:56 pm
Maren – Thanks for your perspective on working with your classmates on the wards. Also, I agree that a throw-away rotation on going back is key no matter when you go back (to 3rd or 4th yr). I think the point I was trying to get across is that if you have important rotations (e.g. a sub-internship) left before the deadline for residency applications then there’s not as much time for easing into the wards.
April 11th, 2009 at 2:32 pm
One possible advantage of doing graduate school after second year is that it leaves you extra time to tie up loose ends after returning to clinic. Granted, you won’t be running into the lab to pipet during your surgery rotation, there’s something to be said for having TWO years following the PhD. Having just gone through a brutal submission process for my first paper, I can attest to the time and patience it can require for your work to reach the literature. Consider the possible scenario where you submit a manuscript to a high-impact journal just as you’re wrapping up the thesis. It is probably to your advantage to have an extra “incubation” year for the paper to make it to press – especially if you can have it done in time to include on your CV for residency interview during Fall/Winter of 4th year. Mudphudder, did you find that interviewers sized up your publication record during the application process? I would speculate that if an MD/PhD has a major paper pending, it could help you alot to be able to tell your programs that it’s been accepted for publication.
April 11th, 2009 at 3:37 pm
Good points Andrew. I know a lot of people who used every minute of the two clinical years after they left graduate school to wrap up loose ends. Just small things like, writing their dissertations or holding their thesis defenses…
I’ll write something soon about mudphudders and the residency process. I think you suggested that a while ago and I think it’s a really good topic. But to address publication record, I strongly suspect that the clinical interviewers are more impressed by a long list of publications rather than high profile publications. For example, I don’t think many residency interviewers could explain the difference between Cell and the Scandanavian Journal of Diagnostic Techniques. Also, with regards to telling interviewers that your paper is “in review”, “accepted” or “in press”, I’m not so sure how well that goes over. There a lot of medical students whose Journal of Orthopedic Pathology articles are “pending” and I suspect applicants whose research hasn’t gone anywhere also use the “in review” or “in preparation” excuse. So I think there is a greatly diminished appreciation if it’s not on pubmed–especially in light of the fact that most interviewers don’t fully appreciate an “accepted”/”in press” high profile article e.g. in Nature/Cell/Science. However, for the few interviewers who do know about high profile journals, it is helpful to be able to say that your publication is accepted.